Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0851184 (thinning)
 11,252 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Goserelin is a gonadotrophin-releasing hormone (GnRH) analogue which, during continuous administration, down-regulates the pituitary-ovarian gonadal axis and reduces levels of the gonadotrophins, luteinising hormone and follicle-stimulating hormone. In women, this results in suppression of ovarian steroidogenesis and a decline in estrogen to levels similar to those observed after menopause or following surgical oophorectomy. Thus, goserelin has a useful role in the management of some benign estrogen-dependent gynaecological disorders. Goserelin is available as a biodegradable sustained release depot 3.6mg injection which is administered every 28 days. In women with endometriosis, monthly injections of depot goserelin were effective in achieving resolution of endometriotic implants and in improving pelvic symptoms, including pain and dyspareunia. Randomised clinical comparisons of depot goserelin with danazol indicate that goserelin is at least as effective as danazol and is better tolerated in the treatment of endometriosis. In the management of uterine leiomyomata (fibroids), goserelin depot injections reduce uterine size and the size of uterine leiomyomata, with maximum clinical benefit achieved approximately 3 to 4 months after initiation of treatment. When used as an adjunctive pretreatment for women undergoing surgical removal of uterine leiomyomata, goserelin was associated with technically easier surgical procedures, reduced intraoperative blood loss and reduced transfusion requirements around the time of surgery. As an alternative to surgery, therapeutic use of goserelin is limited by the rapid regrowth of leiomyomata following cessation of treatment. However, goserelin may be a useful treatment for women approaching menopause, in whom uterine leiomyomata shrink naturally as endogenous estrogen levels decline. In women with dysfunctional uterine bleeding, treatment with depot goserelin before surgery facilitates resection and ablative procedures by suppressing endometrial growth and thinning the endometrial mucosa. Goserelin is also an effective alternative to surgery in this patient group. As adjuvant therapy for women undergoing assisted reproduction procedures, goserelin is associated with reduced cycle cancellation rates and with an increase in the rate of oocyte retrieval. The tolerability profile of goserelin is characterised by adverse effects typical of hypoestrogenism, including hot flushes, loss of libido and loss of bone mineral density. However, concomitant 'add-back' hormone replacement therapy appears to effectively reduce these hypoestrogenic symptoms. In summary, the availability of depot goserelin has broadened the spectrum of effective treatments for benign estrogen-dependent gynaecological disorders. As goserelin is effective as a sustained release depot formulation suitable for administration on a monthly basis, it is also a convenient and practical treatment choice.
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PMID:Goserelin. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic use in benign gynaecological disorders. 880 70

A randomized controlled trial of 160 patients undergoing endometrial laser ablation (ELA) was performed. Patients selected for ELA were randomized to receive either danazol or the GnRH analog Zoladex. Eighty patients were allocated to each group. Each group was also randomized to receive either 1 or 2 months of treatment prior to surgery The major end points for the study were patient compliance and drug-related side-effects, operative time and complications, effectiveness of endometrial thinning as judged by ultrasound, histologic measurements, and clinical response at 6 months assessment. Significant differences in the effectiveness of the two preparations were noted.
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PMID:A Prospective Randomized Trial Comparing a GnRH Analog, Zoladex, and Danazol as Agents for Priming the Endometrium Prior to Endometrial Laser Ablation 907 99

Our objective was to evaluate the effect of endometrial thinning by GnRH agonists on the results of hysteroscopic endometrial electrosurgical resection. In a prospective study, 32 women were treated with the GnRH agonist goserelin (Zoladex) before hysteroscopic endometrial resection. Endometrial thickness was measured before and after GnRH-a therapy by ultrasound. Short-term results in diminished vaginal blood loss and patient satisfaction were registered. The mean endometrial thickness (ET) before GnRH-a is 3.7 mm and after GnRH-a is 1.9 mm. In 24 cases, ET was reduced by a mean of 2.6 mm, in 1 case, no change was seen, and in 7 cases, ET increased by a mean 1.1 mm. The mean thickness rate (TR = ET before and after GnRH) is 2.7 (range 0.3-11). Fluid resorption during hysteroscopic surgery does not relate to ET or TR. Although the ET after GnRH-a therapy is not related to success or failure of the endometrial resection, there is some evidence that the TR is, probably expressing a more active state of the endometrium. Endometrial thinning by GnRH-a may have an effect on the results of hysteroscopic endometrial resection. In light of the present study and the literature, there seems to be no justification for abandoning preparation of the endometrium before hysteroscopic surgery.
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PMID:Endometrial electrosurgical resection by hysteroscopy in 32 menorrhagic patients: endometrial preparation with a GnRH agonist may have some effect on results. 1015 Jun 56